Hyperbaric Oxygen Sessions Research Articles

Hyperbaric oxygen therapy in the ATLS/ACLS resuscitative management of acutely ill or severely injured patients with severe anemia: a review.

For short periods, even without the presence of red blood cells, hyperbaric oxygen can safely allow plasma to meet the oxygen delivery requirements of a human at rest. By this means, hyperbaric oxygen, in special instances, may be used as a bridge to lessen blood transfusion requirements. Hyperbaric oxygen, applied intermittently, can readily avert oxygen toxicity while meeting the body's oxygen requirements. In acute injury or illness, accumulated oxygen debt is shadowed by adenosine triphosphate debt. Hyperbaric oxygen efficiently provides superior diffusion distances of oxygen in tissue compared to those provided by breathing normobaric oxygen. Intermittent application of hyperbaric oxygen can resupply adenosine triphosphate for energy for gene expression and reparative and anti-inflammatory cellular function. This advantageous effect is termed the hyperbaric oxygen paradox. Similarly, the normobaric oxygen paradox has been used to elicit erythropoietin expression. Referfusion injury after an ischemic insult can be ameliorated by hyperbaric oxygen administration. Oxygen toxicity can be averted by short hyperbaric oxygen exposure times with air breaks during treatments and also by lengthening the time between hyperbaric oxygen sessions as the treatment advances. Hyperbaric chambers can be assembled to provide everything available to a patient in modern-day intensive care units. The complication rate of hyperbaric oxygen therapy is very low. Accordingly, hyperbaric oxygen, when safely available in hospital settings, should be considered as an adjunct for the management of critically injured or ill patients with disabling anemia.

Five sessions of hyperbaric oxygen for critically ill patients with COVID-19-induced ARDS: A randomised, open label, phase II trial

BackgroundFew treatment options exist for patients with COVID–19–induced acute respiratory distress syndrome (ARDS). Data on the benefits and harms of hyperbaric oxygen treatment (HBOT) for this condition is limited. ObjectiveTo evaluate benefits and harms of HBOT in patients with COVID-19 induced ARDS. MethodsIn this open-label trial conducted at three hospitals in Sweden and Germany, patients with moderate to severe ARDS and at least two risk factors for unfavourable outcome, were randomly assigned (1:1) to medical oxygen 100 %, 2·4 Atmospheres absolute (ATA), 80 min (HBOT) adjuvant to best practice or to best practice alone (Control). Randomisation was stratified by sex and site. The primary endpoint was ICU admission by Day 30. ResultsBetween June 4, 2020, and Dec 1, 2021, 34 subjects were randomised to HBOT (N = 18) or Control (N = 16). The trial was prematurely terminated for futility. There was no statistically significant difference in ICU admission, 5 (50 %) in Control vs 13 (72 %) in HBOT. OR 2·54 [95 % CI 0·62-10·39], p = 0·19. Harms102 adverse events (AEs) were recorded. 16 (94 %) subjects in the HBOT group and 14 (93 %) in the control group had at least one AE. Three serious adverse events (SAEs), were at least, possibly related to HBOT. All deaths were unlikely related to HBOT. ConclusionsHBOT did not reduce ICU admission or mortality in patients with COVID–19–induced ARDS. The trial cannot conclude definitive benefits or harms. Treating COVID–19–induced ARDS with HBOT is feasible with a favourable harms profile.

Hyperbaric oxygenation helps you live comfortably history of hyperbaric oxygenation

The article highlights historical aspects and conducts a retrospective analysis of the use of hyperbaric oxygenation, presents types of pressure chambers, pays attention to the use of hyperbaric oxygenation, analyzes the method, preparation and conduct of a hyperbaric oxygenation session.

The Effects of Antioxidants and Hyperbaric Oxygenation at Severe Thermal Injury: a Prospective Study

INTRODUCTION. Severe thermal injury (STI) characterized, among others, by hypoxia and oxidative stress (OS). The possibility of maintaining the antioxidant system through the antioxidants usage is proposed, but their effectiveness and duration are debatable issues. On the other hand, correction of OS at STI is theoretically possible by hyperbaric oxygenation (HBO) sessions, but there is a need to assess the benefit-risk ratio. AIM. Investigate the effect of antioxidants and hyperbaric oxygenation sessions on the course of oxidative stress at severe thermal injury. MATERIALS AND METHODS. This study involved conditionally healthy individuals (n = 25), and patients with STI (n = 31), randomized into 3 groups: standard methods (n = 11), supplemented with antioxidants (daily injecting of 250 g vitamin C, 1.494 g “Cernevit” and 10 ml “Addamel N” during 14 days, n = 11) or HBO sessions (50–60 minutes in pressure chambers BLKS-30, BLKS-307/1 in the “low dose” at 1.3 Ata, n = 9). Plasma and erythrocytes were evaluated for free radical oxidation (FPO) and total antioxidant activity, malonic dialdehyde (MDA) concentration, activity of superoxide dismutase (SOD), catalase, and glutathione reductase. RESULTS AND DISCUSSION. At the antioxidant usage was found SOD activity increase by 11 % (p 0.01) on the second day, a decrease in FROer by 13 % (p = 0.012) on the 9th day, and MDAer by 13 % (p = 0.036) on the 6th day. In the HBO group, there was 9 % increase in SOD activity (p = 0.038) after the first session, an increase in glutathione reductase activity by 15 % (p = 0.028) by the 9th day. Thus, it is possible to pre-limit the period of potentially favorable use of antioxidants and HBO, which contributes to the maximum therapeutic effect. The negative consequences caused by the use of antioxidants or HBO have not been identified in this work. CONCLUSION. The antioxidant usage at STI contributes to the growth of the antioxidant protection of erythrocytes. The HBO usage leads to an improvement in cellular respiration and antioxidant enzymes activity and does not cause a deepening of OS. The optimal duration of prescribing antioxidants is the first 6–8 days, HBO — 9–11 days from the beginning of therapy.

Динамика депрессивных и психосоматических симптомов при гипербарической оксигенации в терапии пациентов с long-covid инфекцией

Purpose: To examine the dynamics of depressive and psychosomatic symptoms with hyperbaric oxygenation in therapy of patients with long COVID-19. Material and Methods: Patients with long COVID-19 (n = 52) who underwent 15 sessions of hyperbaric oxygenation in the Polyclinic No. 2 of the Federal State Budgetary Institution Federal Medical and Biological Center of Russia completed the Giessen questionnaire for self-assessment of psychosomatic symptoms before and after therapy. The patient depressive symptoms were also assessed before and after therapy by psychiatrists using the Hamilton Rating Scale for Depression. Results: The results showed a decrease in depressive symptoms, exhaustion, gastric and cardiac complaints, and overall symptom pressure after hyperbaric oxygen therapy. Rheumatic factor appeared to be the only psychosomatic symptom that did not decrease after therapy. Conclusion: Overall, depressive and psychosomatic symptoms are persistent with long COVID-19, and hyperbaric oxygenation may be effective in treating this symptomatology.

Comparing the Blood Response to Hyperbaric Oxygen with High-Intensity Interval Training-A Crossover Study in Healthy Volunteers.

High-intensity interval training (HIIT) and hyperbaric oxygen therapy (HBOT) induce reactive oxygen species (ROS) formation and have immunomodulatory effects. The lack of readily available biomarkers for assessing the dose-response relationship is a challenge in the clinical use of HBOT, motivating this feasibility study to evaluate the methods and variability. The overall hypothesis was that a short session of hyperbaric oxygen (HBO2) would have measurable effects on immune cells in the same physiological range as shown in HIIT; and that the individual response to these interventions can be monitored in venous blood and/or peripheral blood mononuclear cells (PBMCs). Ten healthy volunteers performed two interventions; a 28 min HIIT session and 28 min HBO2 in a crossover design. We evaluated bulk RNA sequencing data from PBMCs, with a separate analysis of mRNA and microRNA. Blood gases, peripheral venous oxygen saturation (SpvO2), and ROS levels were measured in peripheral venous blood. We observed an overlap in the gene expression changes in 166 genes in response to HIIT and HBO2, mostly involved in hypoxic or inflammatory pathways. Both interventions were followed by downregulation of several NF-κB signaling genes in response to both HBO2 and HIIT, while several interferon α/γ signaling genes were upregulated. Only 12 microRNA were significantly changed in HBO2 and 6 in HIIT, without overlap between interventions. ROS levels were elevated in blood at 30 min and 60 min compared to the baseline during HIIT, but not during/after HBO2. In conclusion, HBOT changed the gene expression in a number of pathways measurable in PBMC. The correlation of these changes with the dose and individual response to treatment warrants further investigation.

Lipid peroxidation and the antioxidant system of the lungs during hyperbaric oxidation and its aftereffect: prospective study

OBJECTIVE. To study the state of lipid peroxidation (LP) and the antioxidant system in the lungs of a healthy organism with single and repeated use of HBO in the therapeutic regime and the dynamics of the detected changes in the posthyperoxic period.
 MATERIALS AND METHODS. The experiments were conducted on a 100 mongrel white rats (males) weighing 180-220 g. Hyperbaric oxygenation (HBO) was performed in a therapeutic “soft” mode (2 ata, 50 min), 1 session per day. The studies were carried out immediately after the first and fifth sessions of HBO, as well as on the 5th day after a single application of HBO and on the 5th knock after the end of the five-day course of HBO. The content of extraerythrocytic hemoglobin (EEG), malondialdehyde (MDA), urea, uric acid (UC), activity of superoxide dismutase (SOD) and catalase were studied in the lung tissue.
 RESULTS. A five-day course of HBO does not lead to the accumulation of EEG in the lung tissue and causes an increase in the concentration of MDA in it only after the 5th session of HBO, whereas on the 5th day of the posthyperoxic period (PHP) it is within the normal range. Adapting to the selected HBO regimen, the lung tissue responds by increasing the activity of SOD and catalase, which normalize with an increase in the number of sessions to five. Unlike SOD, the increase in catalase activity on the 5th day of PHP depends on the number of HBO sessions. If the HBO-determined accumulation of urea by the lung tissue persists on the 5th day of the post-peroxic period, then the accumulation of UC is only with hyperoxic exposure.
 DISCUSSION. The changes we have identified are a manifestation of the natural reaction of the LP and the antioxidant system of the lungs of a healthy organism to an over-saturation with oxygen carried out in a therapeutic “soft” mode of 2 ata, 50 min.
 CONCLUSION. A five-day course of HBO in a therapeutic “soft” mode (2 ata, 50 min, 1 session per day) does not cause uncontrolled activation of POL and depletion of the antioxidant system in the lung tissue.

HBO aftereffect on lipid peroxidation and enzyme antioxidants of the brain: prospective experiental study

OBJECTIVE. Study the effect of a single and multiple administration of hyperbaric oxygenation (HBO) in the therapeutic regime on the processes of lipid peroxidation (LPO) and enzyme of antioxidative defense in phylogenetically various structures of the brain in the period of the immediate and remote aftereffect of expositions.
 MATERIALS AND METHODS. Experiments were carried out on 87 nonlinear white male rats weighing 180-230 grams. Hyperbaric oxygenation was conducted by medical oxygen in the experimental pressure chamber in the “mild” mode (2 ata, 50 min isopression), 1 session per day in the morning. The study was carried out after 1, 5, 10 sessions, in 5 and 10 days after 1 session and in 5 days after 5 sessions of HBO. The content of malondialdehyde (MDA) was determined in the brain stem, cerebellum and large brain hemispheres. The state of an enzyme element of antioxidant defense was evaluated by superoxide dismutase (SOD) and catalase.
 RESULTS. It was found that exposure to oxygen under high pressure caused increased intensity of LPO processes in the brain that progresses from 1 to 5 sessions. While MDA changes in the brain stem were detected later than in the hemispheres and cerebellum. LPO intensification in the brain proceeded against the background of increased activity of SOD. After 10 sessions of HBO LPO intensity decreased that was confirmed by reduced MDA content and SOD activity in examined brain tissue. Catalase activity reduced in the stem after 5 sessions and increased in the cerebellum and hemispheres after 10 sessions of HBO. Aftereffect of 1 HBO session was characterized by persistent increase in MDA concentration in the brain regions, detected in 5 and 10 days after exposure and was accompanied by increased SOD activity against the background of reduced catalase activity. In 5 days after 5 sessions the increase in MDA content and SOD activation was observed only in the tissue of the cerebral hemispheres.
 DISCUSSION. The use of HBO in the mode 2 ata, 50 min stimulates reactions of free radical oxidation (FRO) in the brain. The dynamics of their development with continued exposure shows that there are enough resources of the brain antioxidant defense to compensate hyperoxic load, including 10-fold exposure and no depletion of the reserves of enzyme antioxidant element in the brain is observed. After a single exposure of hyperbaric oxygen FRO activation remains during 10 days that can be concluded from an increased level of MDA and an increased activity of SOD in all the brain regions against the background of reduced catalase activity of stem structures and cerebellum. Repeated 5-fold exposures have a shorter metabolic “footprint”: in 5 days LPO effect and SOD activation are less pronounced than in the period of 1 session aftereffect both in 5 and 10 days.
 CONCLUSION. The therapeutic “mild” mode of HBO (2 ata, 50 min, 1 session per day) causes FRO activation in the brain tissue of experimental animals. Its intensity is controlled by the activation of enzyme protection mechanisms that is enough to compensate FRO changes with this mode of hyperoxic load. After ending exposures more pronounced aftereffect of HBO in the brain regions is found after 1 session compared to 5 sessions.

Immediate and Long-Term Effects of Hyperbaric Oxygenation in Patients with Long COVID-19 Syndrome Using SF-36 Survey and VAS Score: A Clinical Pilot Study.

(1) Background: Long COVID syndrome (LCS) is a heterogeneous long-standing condition following COVID-19 infection. Treatment options are limited to symptomatic measures, and no specific medication has been established. Hyperbaric oxygenation (HBO) has been found to have a positive impact on the treatment of COVID-19 infection. This study evaluates both the feasibility and outcome of supportive HBO in patients with LCS. (2) Methods: Within 17 months, 70 patients with proven LCS were prospectively included. Each patient underwent a cycle of 10 subsequent HBO treatment sessions administered for 75 min at 2.2 atmospheres. Evaluation of the patients was performed before the first and after the last HBO session and 3 months afterwards. Statistical evaluation was based on an intention-to-treat analysis using Fisher's exact test and Student's t-test for paired samples. (3) Results: In total, 59 patients (33 females, 26 males; mean age: 43.9 years; range: 23-74 years; median: 45.0) were evaluable. After HBO, a statistically significant improvement of physical functioning (p < 0.001), physical role (p = 0.01), energy (p < 0.001), emotional well-being (p < 0.001), social functioning (p < 0.001), pain (p = 0.01) and reduced limitation of activities (p < 0.001) was confirmed. (4) Conclusions: Physical functioning and both the physical and emotional role improved significantly and sustainably, suggesting HBO as a promising supportive therapeutic tool for the treatment of LCS.

Hypothesis: Drainage of the peripheral tissue edema by the hyperbaric oxygen therapy because of hyperoxygenation that constricts arterioles and alters the downstream capillary fluid traffic in affected tissues.

Hyperbaric oxygen (HBO) therapy still lacks proper interpretations of its many actions. This hypothesis is based on reports of temporarily elevated peripheral vascular resistance (PVR) during HBO sessions. Besides that, during HBO sessions, hyperoxygenated tissues can reduce their perfusion so much that CO2 can accumulate in them. Tissue perfusion depends on vascular innervation and on the balance between systemic constrictors and local dilators. During an HBO session, increased tissue oxygen levels suppress dilatory mechanisms. Tissue hyperoxygenation increases PVR, suggesting that the HBO action on an edematous tissue may be caused by an oxygen-induced disbalance among Starling capillary forces. The presented hypothesis is that oxygen-caused arteriolar constriction reduces the hydrostatic pressure in downstream capillaries. Thus, more tissue fluid is absorbed in vascular capillaries, under the condition that the plasma colloid osmotic pressure remains unaltered during the HBO session. Among several known mechanisms behind the HBO actions, the vasoconstriction has been listed as a therapeutic modality for the reduction of the tissue edema, for a crush injury, for burns (in an acute phase), and for the compartment syndrome. The Bell's palsy is among often listed indications for the HBO treatment, although evidence is poor and reports of randomized trials are scarce.

Hyperbaric oxygen therapy efficacy on mandibular defect regeneration in rats with diabetes mellitus: an animal study

BackgroundThis study aimed to investigate the influence of hyperbaric oxygen therapy on mandibular critical-sized defect regeneration in rats with experimentally induced type I diabetes mellitus. Restoration of large osseous defects in an impaired osteogenic condition such as diabetes mellitus is a challenging task in clinical practice. Therefore, investigating adjunctive therapies to accelerate the regeneration of such defects is crucial.Materials and methodsSixteen albino rats were divided into two groups (n = 8/group). To induce diabetes mellitus, a single streptozotocin dosage was injected. Critical-sized defects were created in the right posterior mandibles and filled with beta-tricalcium phosphate graft. The study group was subjected to 90-min sessions of hyperbaric oxygen at 2.4 ATA, for 5 consecutive days per week. Euthanasia was carried out after 3 weeks of therapy. Bone regeneration was examined histologically and histomorphometrically. Angiogenesis was assessed by immunohistochemistry against vascular endothelial progenitor cell marker (CD34) and the microvessel density was calculated.ResultsExposure of diabetic animals to hyperbaric oxygen resulted in superior bone regeneration and increased endothelial cell proliferation, which were revealed histologically and immunohistochemically, respectively. These results were confirmed by histomorphometric analysis which disclosed a higher percentage of new bone surface area and microvessel density in the study group.ConclusionsHyperbaric oxygen has a beneficial effect on bone regenerative capacity, qualitatively and quantitively, as well as the ability to stimulate angiogenesis.

A randomized trial of one versus three hyperbaric oxygen sessions for acute carbon monoxide poisoning

Introduction: Hyperbaric oxygen (HBO2) improves outcome in patients with acute carbon monoxide (CO) poisoning, but optimal dose/timing are unknown. In this double-blind, sham-controlled randomized trial, we compared neuropsychological sequelae at 6 weeks and 6 months in patients receiving 3 HBO2 sessions or 1 HBO2 session and 2 sham chamber sessions after acute CO poisoning. Methods: After completing 1 HBO2 session (3.0 ATA, 60 minutes, 2.0 ATA, 65 minutes), CO-poisoned patients were randomized (1:1): 2 sham chamber sessions (1 ATA air, 120 minutes) or 2 additional HBO2 sessions (2.0 ATA, 90 minutes at pressure, 120 minutes in chamber) completed within 24 hours. Eligible patients were &lt;24 hours from accidental poisoning, English-speaking, and not intubated. We planned 150 participants. Results: The study was stopped early for enrollment futility. From 2006-2016, we screened 395 patients, 136 were deemed eligible to participate, and 75 signed informed consent. Two were later withdrawn for past brain injury/PTSD (1 sham, 1 HBO2), and 1 for performance validity (sham). Of the 72 analyzed, mean age was 42±15 years, 40 (56%) were male, 20 (28%) had loss of consciousness, and mean initial carboxyhemoglobin was 22±9%. The rate of 6-week neuropsychological sequelae was 50% in the 1 HBO2 session group and 55% in the 3 HBO2 sessions group (p=0.80), and at 6 months was 42% vs 46%, respectively (p=0.76). Conclusions: There was no difference in the rate of neuropsychological sequelae in those who received 3 HBO2 sessions and those who received 1 HBO2 sessions and 2 sham sessions. The higher rate of neuropsychological sequelae compared to an earlier study may be due to neuropsychological test-retest effects or previously identified risk factors for cognitive sequelae (age, duration of poisoning, cerebellar dysfunction). This study’s rates of cognitive difficulties, affective complaints, and other symptoms suggest brain injury after CO poisoning is common.

Actinomycosis osteomyelitis of the mandible in a 71-year-old patient: A Case Report

We herein present the treatment of an actinomycosis osteomyelitis case. A 71-year-old female with a dental history of multiple tooth extractions two years prior who subsequently developed chronic osteomyelitis. Previous treatment included 10 sessions of hyperbaric oxygen and pentoxifylline tocopherol protocol as well as debridement of the lesion that had resulted in a subsequent midline pathological fracture of the mandible. The fracture was treated by intra-bony wiring. The clinical extra-oral presentation was that of severe pain, recurrent swelling of the submandibular areas bilaterally and draining fistulae. Our treatment included antibiotic therapy: guided by Microscopy Culture and Sensitivity and a segmental mandibulectomy with the placement of a reconstruction plate. The outcome of the therapeutic management was successful. Histopathology results confirmed chronic osteomyelitis with bacterial colonies in keeping with actinomycosis. At the six-week post-operative appointment, the patient was healing well.

Idiopathic Sudden Sensorineural Hearing Loss: Is Hyperbaric Oxygen Treatment the Sooner and Longer, the Better?

(1) Background: We aimed to evaluate hearing benefits from hyperbaric oxygen (HBO) therapy in patients with Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). (2) Methods: We performed a retrospective analysis of chart reviews on patients with ISSHL between Jan 2016 and Dec 2021. All patients were referred to receive HBO therapy by the department of Ear, Nose and Throat (ENT). Hearing gain was assessed based on pure-tone audiometry (PTA). Data were analyzed for 102 patients after 1 to 5 therapy sessions, and for 46 patients after 6 to 10 therapy sessions. (3) Results: After 1–5 HBO sessions, patients (N = 102) showed an improvement in 45 (44.1%) of the patients (p < 0.000). Also, improvements were found with patients showing different grades of ISSHL: 11 (26.8%) with slight-moderate, 11 (40.7%) with severe, and 23 (67.6%) with profound ISSHL. Significant treatment effects were found at different affected frequencies, especially the low frequency range. After 6–10 HBO sessions, patients (N = 46) showed similar treatment effects as after 1–5 HBO sessions, but no additional improvement. Moreover, patients who received HBO treatment within 12 days showed improvement effects 6.484 times greater (p < 0.000) compared with those who received treatment after 13 days. (4) Conclusions: The improvement of HBO therapy on ISSHL was significant after 1–5 sessions, with larger improvements for those suffering more serious symptoms. Further adding more HBO treatment sessions to 6–10, no further improvement was found. Patients starting HBO therapy within 12 days of ISSHL showed 6.484 times greater improvements compared with those starting HBO therapy later.

Platelet and leukocyte rich fibrin (L-PRF) applied in necrotizing Fasciitis treatment: case report

The reconstruction of extensive defects on the face caused by infections is a challenge for the oral and maxillofacial surgeon. Platelet and leukocyte-rich fibrin (L-PRF) is an excellent option for rehabilitative treatment, as it contains molecular and cellular elements that induce repair, being a therapeutic biomaterial with high potential for soft tissue regeneration. This article presents the clinical case of the patient C.T.A.S., female, 21 years old, who reported multiple tooth extractions, with an evolution of 30 days of volume increase and intense algesia in the left bucal space. Diagnosing necrotizing fasciitis, the patient underwent IV antibiotic therapy and surgery to drain and debride the lesion. Postoperatively, therapy with platelet- and leukocyte-rich fibrin was initiated for tissue regeneration in the area affected by fasciitis. As an adjuvant to L-PRF membranes, low-level laser therapy and hyperbaric oxygenation sessions were performed. When using L-PRF to resolve this case, a satisfactory result was observed regarding the aesthetic-functional repair. In addition to having the advantage of being cost-effective, and having a simple protocol to be performed, L-PRF proved to be effective in promoting tissue regeneration.

Impact of Acute Hyperbaric Oxygen Treatment on Phrenic Motor Output in Adult Male Rats

Hyperbaric oxygen (HBO) therapy involves exposure to 100% oxygen delivered above one atmosphere absolute (ATA), typically for ≤1 hour. HBO therapy is commonly used for promoting wound healing and treating decompression sickness. HBO treatment radically increases arterial oxygen content and can stimulate production of anti‐oxidants and suppress inflammation. These and other HBO‐induced responses could potentially impact the neural regulation of breathing. Here we investigated if exposure to HBO (100% O2, 2 ATA, 1 hr) impacts baseline phrenic motor output or the ability to express phrenic long term facilitation induced by acute intermittent hypoxia (AIH). Adult male Sprague‐Dawley rats were treated with HBO (n=8) or sham treatment (n=7, room air, 1 ATA), and then immediately urethane‐anesthetized and mechanically ventilated. Rats were vagotomized and phrenic nerve output was recorded using a suction electrode. On average, 86±23 min elapsed from the end to HBO treatment to the initiation of phrenic recordings. After establishing the CO2 apneic and recruitment thresholds, a stable baseline was maintained at 2 mmHg above of recruitment threshold for 15‐20 min. Rats were then exposed to AIH which consisted of three 5‐min episodes of moderate hypoxia (arterial partial pressure of O2, PaO2, approximately 45 mmHg) separated by 5‐min intervals of baseline O2conditions. Arterial samples were drawn at baseline, during hypoxia and every 20 min following AIH for blood‐gas analysis. Phrenic activity was recorded for 60 min after AIH. An unpaired two‐tailed t‐test was applied to compare baseline (BL) parameters between groups. Analysis of long term facilitation of phrenic burst amplitude after AIH (expressed as %BL) was done using two‐way repeated measures ANOVA. The HBO treatment did not affect baseline parameters including phrenic burst amplitude (p=0.34), burst frequency (p=0.48), mean arterial blood pressure (p=0.66), PaO2 (p=0.86) or PaCO2 (p=0.27). Phrenic LTF tended to be greater in the HBO group (burst amplitude 81±50 %BL at 60 min) as compared to control (43±9 %BL at 60 min). However, this difference was not statistically significant (treatment effect, P=0.16). Our preliminary conclusion is that a single session of HBO at 2 ATA for 1 hour has no detectable impact on baseline phrenic motor output recorded approximately 90 minutes after end of the HBO treatment. Additional experiments are needed before drawing a firm conclusion regarding the impact of HBO on phrenic long‐term facilitation.

Diaphragm EMG activity during hyperbaric oxygen exposure in spinal injured rats

Cervical spinal cord injury can cause significant respiratory dysfunction and in severe cases necessitates mechanical ventilation. Accumulating evidence indicates that hyperbaric oxygen (HBO) therapy, initiated shortly after spinal cord injury (SCI), can mitigate spinal cord pathology. Further, a recent study from our group demonstrated that HBO therapy can attenuate diaphragm atrophy after SCI. The primary purpose of the present investigation was to evaluate diaphragm electromyogram (EMG) activity during HBO therapy in rats with cervical SCI. HBO therapy has not been widely adopted after SCI, and if HBO is to be translated to human use, we reasoned that it is important to determine how breathing is impacted during HBO exposure. Adult female Sprague‐Dawley rats were implanted with chronic indwelling EMG electrodes in the mid‐costal diaphragm two weeks prior to SCI. Following hemicontusion injury of the C4 spinal cord, one experimental group was treated with HBO (n=3), and another group was left untreated (n=3). The HBO treatment consisted of a one hour exposure to 100% O2 at 3 atmospheres (ATA). In all experiments, diaphragm EMG activity was recorded in freely moving rats, without anesthesia. Recordings were made for 10 minutes prior to treatment, throughout the HBO exposure, and for 10 minutes after. Diaphragm EMG recordings in the normobaric normoxia control group conditions were completed for the same duration of time as the treated group. Daily HBO treatment and EMG recordings were done until 10‐days post‐SCI. Peak diaphragm EMG burst amplitude was quantified before SCI, over the 10 days of treatment, and at 1 and 2 weeks post‐treatment. Prior to SCI, body weight was similar between groups (control: 227±4 g; HBO: 228±3 g). All rats with tolerated HBO treatment with no evidence of adverse events or impact on weight gain over the 10 day period (10 day body weight: control: 198 ± 14 g; HBO: 197 ± 13 g). The acute HBO exposure caused an increase in the area under the curve of the rectified and integrated inspiratory burst amplitude of the diaphragm recording made ipsilateral to the lesion. This increase averaged 126 ± 18% of baseline across the 10 HBO treatments. The ipsilateral EMG burst amplitude also remained elevated at 10 min post‐HBO exposure (115 ± 32%) compared to pre HBO exposure. At the conclusion of the 10 day treatment paradigm, ipsilateral diaphragm EMG output during quiet breathing was elevated in HBO (156 ± 50% of post‐injury baseline) as compared to the control group (111 ± 6% of baseline). However the ipsilateral diaphragm EMG burst amplitude of the two groups were similar when evaluated 2 weeks after the daily HBO sessions concluded. This ongoing study indicates that acute exposure to HBO therapy is associated with an increase in diaphragm EMG activity, and 10 days of HBO therapy accelerates the recovery of diaphragm activation following cervical contusion injury.

Hyperbaric oxygen therapy in rehabilitation of patients after COVID‑19

Severe complications of COVID‑19 are pneumonia and the development of acute respiratory distress syndrome, which is accompanied by hypoxia. Tissue hypoxia increases against the background of inflammatory reactions and hypercoagulation. Hyperbaric oxygenation can effectively reduce systemic hypoxia, improve blood circulation, has a beneficial effect on reducing the severity of the inflammatory condition by modulating oxidative stress, including lipid peroxidation, and increasing antioxidant enzymes. A review of clinical studies conducted in different countries shows the overall effectiveness of systemic maintenance therapy with the inclusion of hyperbaric oxygenation, which reduces the use of artificial ventilation and reduces the mortality rate of severely ill patients with COVID‑19. The article presents the results of our own research on the rehabilitation of 10 patients who had a severe form of COVID‑19. The inclusion in the rehabilitation of COVID‑19 patients of daily sessions of hyperbaric oxygenation in ‘soft’ modes (1,4–1,6 ATA) in combination with respiratory and physical gymnastics showed a positive effect and safety. In patients, shortness of breath decreased, blood saturation indicators improved, cognitive functions decreased, the severity of anxiety and depression decreased, and exercise tolerance increased.

Профілактика і лікування пролежнів у відділенні інтенсивної терапії (огляд літератури)

У статті з позиції Міжнародної національної нарадо-рекомендаційної ради з пролежнів, Європейської рекомендаційної ради з пролежнів, Всесвітнього альянсу з проблем пролежнів наведено питання термінології, статистики, факторів ризику розвитку, міжнародної класифікації, основних напрямків профілактики, диференціальної діагностики, інспекції шкірних покривів і документування; наведено шкали для прогнозування ризику розвитку пролежнів (PUSH Toll, 2008); викладені вузлові питання інтенсивної терапії залежно від результатів категорії пролежнів; надано правило SPECIAL; рекомендації робочої групи ICSI. Наведено практичні рекомендації Американської колегії фізіотерапевтів. Особливу увагу приділено принципам нутритивної терапії за наявності пролежнів.

Гипербарическая оксигенация в комплексном лечении эмоционального выгорания врачей, связанного с COVID-19

Study Objective: To assess the efficacy of adding hyperbaric oxygenation (HBO) in Oxysys 4500 oxygen cabinet to a set of rehabilitative measures in healthcare professionals with emotional burnout syndrome (EBS). Study Design: Open-label prospective randomized comparative cohort study. Materials and Methods. We have examined 79 healthcare professionals who experienced stress during the COVID-19 pandemic. We have studied changes in the psychoemotional state of subjects during rehabilitation that included HBO procedures in Oxysys 4500. We used Beck’s depression test, State-Trait Anxiety Inventory, and methods for professional burnout diagnostics developed by C. Maslach and S. Jackson. Study Results. EBS and psychoemotional consequences of the stress were observed in two-thirds of respondents, predominantly in young persons, and were more often (р ≤ 0,05) recorded in subjects who did not have COVID-19. The contribution of the stress and state anxiety in the formation of EBS symptoms allows making them a target for psychoemotional stabilisation and elimination of consequences of the occupational stress. Addition of HBO sessions to the therapy resulted in reduction in depression and reduced state anxiety. Conclusion. The high efficacy of HBO addition to rehabilitation of healthcare professionals with EBS has been demonstrated. Keywords: emotional burnout syndrome, hyperbaric oxygenation, COVID-19.